Robot makes inroads into eye surgery

A Dutch university spinoff has developed a robot that enables eye surgeons to operate with 10 to 20 times higher precision. Recently winning a major innovation award, the robot's creators aim to be the first on the market with a product for robot-assisted eye surgery.

The PRECEYES Surgical System promises to not only improve existing eye surgery procedures but also to help surgeons develop new treatments for eye diseases that have no adequate treatment today. (Image courtesy of PRECEYES.)

While robots have been used to aid various types of surgery since the late 1980s, there is still no commercially available robotic system for eye surgery. That is something Gerrit Naus and colleagues at PRECEYES Medical Robotics are planning to change within the next two years.

At the recent London EURETINA Congress – a major conference for eye care professionals – the company won the Science & Medicine Innovation Award.

“We are very happy with this recognition, which is an important endorsement by the European Society of Retina Specialists,” says Naus. “The fact that it’s awarded by the end users of the technology confirms that our innovation is really significant.”

Steadying the hands of surgeons

While developing the PRECEYES Surgical System, Naus and his engineering colleagues have collaborated closely with multiple surgeons. Extensive testing has shown that the robotic instrument improves the precision of surgeons 10 to 20 times by filtering away even the most imperceptible shaking of the surgeons’ hands. This level of steadiness will assist surgeons in performing some of the most difficult procedures in eye surgery, where precision is crucial.

“Our first goal is to improve the reproducibility and precision of existing vitreoretinal surgical procedures – surgery inside the eye, at the retina,” Naus explains. “The procedures that we target are vitrectomy and membrane peeling.”

To perform surgery at the retina – the nerve tissue at the back of the eye, the surgeon pierces the eye with tiny instruments. The limited precision of a human hand limits the range of surgical procedures possible to do by hand. (Image courtesy of PRECEYES.)

The retina is a thin layer of light-sensitive tissue at the back of the eye that converts images into nerve signals and sends them to the brain. Aging, eye injuries, inflammation and diseases such as diabetes can give rise to various problems at the retina, potentially leading to poor eyesight or even blindness. But surgery targeting the retina and the vitreous humour – the gel-like substance that fills the eye – can often restore good vision.

Enabling new treatments

“Our second goal is to enable surgeons to do procedures they cannot do by hand,” Naus says. “This means they will be able to develop new procedures for diseases that have no adequate treatment today.”

One such disease is dry age-related macular degeneration (AMD), the biggest eye disease in industrialised countries and the second biggest worldwide. Another is retinal vein occlusion (RVO).

“Right now surgeons can only treat the complications resulting from dry AMD or RVO – they cannot treat the disease itself,” Naus explains. In the case of RVO, one option to treat the disease itself might be to inject a drug into the vein. This would involve piercing the vein – which is thinner than a human hair – and keeping the needle still for up to ten minutes. Such a procedure is out of reach for a human hand.

With many pharmaceutical companies developing drugs to treat diseases in the eye, high precision drug delivery will grow in the coming years, according to Naus. “We have developed a tool to do this. We have collaborated with two big pharmaceutical companies, showing that it’s possible to inject drugs with such high precision in the eye.”

Towards automation and office-based surgery

Further ahead, they are planning to automate some of the steps involved in relatively uncomplicated and highly reproducible surgical procedures, such as cataract surgery.

Cataract is the most common eye disease worldwide. In the USA, 11,000 surgeons perform three million cataract procedures every year. Owing to the aging population, the number of procedures is expected to grow faster than the surgeons can handle. “With automation, we will be able to solve this problem and help the surgeons keep up with all those cataract surgeries,” Naus says.

“A future dream is to enable surgeons to perform surgery at their office without the need for an operating theatre,” he adds. “This also matches the trend for more ambulatory surgery settings, and we will be able to support or even enable this development with our technology.”

The robotic system does not replace, but assists, the eye surgeon. It integrates with already existing equipment in the operating room, such as a microscope. (Image courtesy of PRECEYES.)

Walking before running

But before reaching this ultimate goal, the startup wants to make sure it can walk before it attempts to run. “We believe we have to start easy, and make the surgeons confident that the system really helps to improve their surgery. Therefore, we initially focus on this relatively simple manipulating tool that assists the surgeon to get high precision,” Naus explains.

“For now, we have left out several technical challenges. We don’t add our own vision system, for example. We believe in integrating into the current operating room with existing equipment, making sure that surgeons can still use their €200,000 microscope.”

It was largely this focus on integration of the system, along with its anticipated clinical benefits, that won over the judges at the recent EURETINA award, which came with €20,000 that will help PRECEYES find investors to market the robot.

Clinical tests in human patients are in the pipeline, with results expected by the end of 2015 and release of the product in 2016. None too soon – with an aging population, rising obesity rates and an estimated 140 million diabetic people in the Western world by 2020, all adding to the burden of eye diseases.